(1657) Levosimendan Impact on Venoarterial Extracorporeal Membrane Oxygenation Weaning

Introduction: Levosimendan is a calcium sensitizer inotropic agent that has been suggested to facilitate weaning from Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) in cardiogenic shock (CS) given its ventricular unloading effects. Therefore, we conducted this study to evaluate the impact of levosimendan on VA-ECMO weaning.

Methods: This retrospective observational cohort study was conducted at the national tertiary cardiology center in Qatar. We included all patients with CS requiring VA-ECMO during the index admission between 1/06/2016 and 1/06/2022. The study population was divided into two groups according to levosimendan use: (1) patients received levosimendan for 24 hours while on VA-ECMO; (2) patients received standard care with other inotropic agents. The primary outcome was successful weaning from VA-ECMO, defined as maintaining stable hemodynamics without VA-ECMO re-insertion within 30 days of weaning, and the secondary outcomes were 30-day all-cause mortality and Velocity Time Integral (VTI) change with levosimendan use before decannulation. Multivariate logistic regression was used to determine the outcomes, and P-value < 0.05 indicated statistical significance.

Results: A total of 110 patients were included. Most patients were male (90%) with a mean age of 53±11 years. The majority of patients were admitted with ST-elevation myocardial infarction (87%). A total of 23 (21%) received levosimendan (group I), while the remaining 79% received other inotropic agents, including dobutamine and milrinone (group II). Levosimendan use, in comparison to standard care with other inotropes, resulted in comparable weaning rate and all-cause mortality (weaning: 16 (70%) vs. 55 (63%), aOR 0.89 (0.26-3.05), P-value= 0.854; all-cause mortality: 8 (35%) vs. 39 (45%), aOR 1.20 (0.38-3.84), P-value= 0.759). Interestingly, levosimendan was associated with a significant increase in VTI (before levosimendan: 6.6 ± 2.5 cm; after levosimendan: 12 ± 3.3 cm, P-value < 0.001).

Conclusions: Our findings suggest that levosimendan use in VA-ECMO for CS significantly increased VTI, compared to other inotropes, yet was associated with similar weaning. Larger studies are needed to confirm the promising effect of levosimendan on VTI improvement, leading to successful weaning.